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PL-16-2134 Inspection Worksheet Miami Shores Village 10050 N.E.2nd Avenue Miami Shores,FL 1 Phone: (305)795-2204 Fax:(305)756-8972 Inspection Number. INSP-264382 Permit Number: PL-7-16-2134 Scheduled Inspection Date: November 28,2016 Permit Type: Plumbing - Residential Inspector: Hernandez,Rafael Inspection Type: Final Owner. DE BRUMN,GERALD&ANABEL Work Classification: Addition/Alteration Job Address:812 NE 92 Street Miami Shores,FL 33138- Phone Number (305)299-7252 Parcel Number 1132060050190 Project: <NONE> Contractor. TITAN PLUMBING REPAIR LLC Phone: (786)487-9288 Building Department Comments REMOVAL AND REPLACEMENT OF KITCHEN SINK, Infractio Passed Comments FAUCET,AND DISHWASHER. INSTALLATION ON NEW INSPECTOR COMMENTS False KITCHEN SINK, FAUCET,AND DISHWASHER. Inspector Comments Passed Failed Correction a Needed Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid s ° o Miami Shores Village ` � yt pm�in ReSide �` 10050 N.E.2nd Avenue NE F c+ �!� ,I�lOrki�'�i�l .� ���t@1"��'►rlt;, . Miami Shores,FL 33138-0000 Phone: (305)795-2204oft tt7l201 Expiration: 03/06/2017 Project Address Parcel Number Applicant 812 NE 92 Street 1132060050190 GERALD&ANABEL DE BRUIJN Miami Shores, FL 33138- Block: Lot: Owner Information Address Phone cell GERALD&ANABEL DE BRUIJN 812 NE 92 Street (305)299-7252 MIAMI SHORES FL 33138- 812 NE 92 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 1,050.00 TITAN PLUMBING REPAIR LLC (786)487-9288 Total Sq Feet: 0 Type of Work:REMOVAL AND REPLACEMENT OF KITCHEN Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Bond Return: Final Classification:Residential Scanning:3 Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PL-7-16-60795 DBPR Fee $2'25 09/07/2016 Cash $ 116.70 $50.00 DCA Fee $2.25 Education Surcharge $0.40 07/29/2016 Check*114 $50.00 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings,statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above-named contractor to do the work stated. September 07,2016 Authorized Signature:Owner V A plicant / Contractor / Agent Date Building Department Copy September 07,2016 1 Miami Shores Village �� WQ��' Building Department J 29 2016 10050 N.E.2nd Avenue,Miami Shores, Florida 33138 L Tel:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC201 � BUILDING Master Permit No. Q 2/3� PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL ❑•PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP rr S'Ly CONTRACTOR DRAWINGS JOB ADDRESS: '91 Nt �� City: Miami Shores County: Miami Dade zip: Folio/Parcel#: ����� � "' �� Is the Building Historically Designated:Yes NO OccupancyType:Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): y 51?=m Phone#: ---1&;2- Address: Address: 2 N City: Mt 11AIGS State: Zip: 221 Tenant/Lessee Name: / Phone#: Email: C? 1 �� T�D �"➢ ) CONTRACTOR:Company Name:-'C i A� ��lAN1' te��(-� a?Pc�� ice_ Phone#: — 664%-7(2.6�* Address: I CI S %4,"E SCS C0" g'� — City: State: CLIA P ZIP: 3 6(� Qualifier Name: Ni r4 U10*,A 1E_Z— Phone#: State Certification or Registration#: Certificate of Competency M DESIGNER:Architect/Engineer: Phone#: Address: City: State: Zip: Value of Work for this Permit:$ _o Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration ❑ New [�Repair/Replace ❑ Demolition Description of Work: Yn&Et 'j\/1PN1_ Alii ) at�kL4�'Z MJZ;!!! � 6T-- `X- T Cr1 t4 Sa t4 r_, "F:7PvXA C%45'V_ tate? T?;S►�rW� `l�-E.� -t���e - Imo➢ ON K'CW Specify color off(color thru tile: Submittal Fee$ cJV Permit Fee$ C, CCF$ 1 1—® CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ / ` Training/Education Fee$ C3- YO Double Fee$ A Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES,BOILERS, HEATERS,TANKS,AIR CONDITIONERS, ETC..... OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant. As a condition to the issuance of a building permit with an estimated value exceeding$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. �\y Signature Signature OWNER or AAT CONTRACTOR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this day of To v 20 1(0 , by 1M day of �i� 20 /4 by Q O� who is personally known to 4who is personally known to me or who has produced 12L, Dt62 —Zll '7? /-0 as m=who has produce as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: �, � W NOTARY PUBLIC: r Sign: ✓' V wil— Sign: Print: Print: KELLY J VILLA _ Seal: _- ';Y ���IION 3t EE 878455 Seal: ILL.y��'" '.� EXPIRES Feb►uary 26,2017 ;A, .fro g ��� !• ,q MV C®AdI 11gMN 8 BE 878455 l ?1 ' v ..r •. �tl''9- EXPIRES F®biuery 28,2017 APPROVED BY nv s Plans Examiner Zoning --7 Structural Review Clerk (Revised02/24/2014) fops Miamishores 'Vwillage Building Department ua'Ri� 10050 N.E.2,nd Avenue Miami Shores, Florida 33138 Tel: (305)795.2204 Fax:(305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. •/ OPY OF QUALIFIER'S STATE LICENCES B._ ZCOPY OF LOCAL L B USINESS TAX RECEIPT C. COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E_ COPY OF WORKERS COMPENSATION tNSURANC-E* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES,FL 33138 Certificate must specify the description of operations or contractor license number. s■rorrr■rrrrrr■rrrrrrrsrrrrrrsrrrrrrrrerrrrrrrrrrrrrrrrrrrrrrreearrrrrrrrrrrrrrrrrrrrrrrrerr BUSINESS NAME: 'T T 1--%JkC1Z%"4 C BUSINESS ADDRESS: 11-1 -S 1-40 1 OR�S\uet- c TY mwPok STATE 'FLP� ZIP :3 31 Bei BUSINESS PHONE: FAX NUMBER(T CELL PHONE(17P QUALIFIER'S NAME: A24-td Cr® iE`Z QUALIFIER'S LIC NUMBER: t✓J:-r G 14-a q 519 STATE OF FLORIDA _. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487-1395 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 GOMEZ,AARON TITAN PLUMBING REPAIR LLC 1175 NE 109TH STREET MIAMI FL 33161 Congratulations! With this license you become one of the nearly one million Floridians licensed by the Department of Business and STATE OF FLORIDA Professional Regulation. Our professionals and businesses range n from architects to yacht brokers,from boxers to barbeque DEPARTMENT OF BUSINESS AND restaurants,and they keep Florida's economy strong. ^,�..rr' PROFESSIONAL OF, Every day we work to improve the way w2 do business in order CFC1429519 ISSUED:. 02/23/2016 to serve you better. For information about our services, please to onto www.myfloridalicense.com. There you can find more CERTIFIED PLUM8iNG-0ONTRAG`rOR information about our divisions and the regulations that impact GOMEZ,AARON you, subscribe to department newsletters and learn more about TITAN PLUMBING REPAIR LL4 F� the Department's initiatives. Our mission at the Department is: License Efficiently, Regulate Fairly.We constantly strive to serve you better so that you can IS CERTIFIED under the provisions of Ch.489 FS. serve your customers. Thank you for doing business in Florida, Expiration date :AUG 31,2016 L1602230001193 and congratulations on your new license! DETACH HERE RICK SCOTT, GOVERNOR KEN LAWSON,SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD MIR CFC1429519 The PLUMBING CONTRACTOR Named below IS CERTIFIED Under the provisions of Chapter 489 FS. Expiration date: AUG 31, 2016 GOMEZ,AARON TITAN PLUMBING REPAIR=LLc 1175 NE 109TH STREET`"' "''° MIAMI FIL 33161- lL ■ ■ Jh N 1/11•■ 11—1 M r%%/I A1AI [^C/1 46 1 1Cfl77Znnni i ai Local Business Tax Receipt Miami—Dade County, State of Florida —THIS IS NOT A BILL—DO NOT PAY LBT 7198195 BUSINESS NAME/LOCATION RECEIPT NO. EXPIRES TITAN PLUMBING REPAIR NEW BUSINESS SEPTEMBER 30, 2016 1175 NE 109 ST 7480618 MIAMI, FL 33161 Must be displayed at place of business Pursuant to County Code Chapter 8A—Art.9&10 SEC.TYPE OF BUSINESS a OWNER PAYMENT RECEIVED TITAN PLUMBING REPAIR LLC 196 PLUMBING BY TAX COLLECTOR C/O AARON GOMEZ MGR CONTRACTOR 75.00 02/29/2016 Worker(s) 1 CFC1429519 CREDITCARD-16-025281 This Local Business Tax Receipt only confirms payment of the Local Business Tax.The Receipt is not a license, permit,or a certification of the holders qualifications,to do business.Holder must comply with any governmental or nongovernmental regulatory laws and requirements which apply to the business. The RECEIPT N0.above must be displayed on all commercial vehicles—Miami—Dade Code Sec 8a-276. MIAMFDADE>- For more information,visit www.miamidade.novltexcollecto rr 4 ,.---i � �Q CERTIFICATE OF LIABILITY INSURANCE �' 5%1!%LU1b THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(St AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the Policy,certain policies may require an endorsement. A statement on tits certificate does not confer rights to the certificate holder In lieu of such endors s. PROM)M comrDavid Bilu Rick Gibbs, P.A. Insurance Agency PNo (954)581-7740 F ;E9S4)584-9875 1000 S. State Road 7 INSURE KS)AFFOFMW COVE RAGE taw# Plantation FL 33317 INstrreo II�URERA Zndurance B:Granada Insurance Titan Plumbing Repair LLC mviREFtc Amtrust North America 1175 NE 109 St ItvsURERn INSUIMR E' Miami FL 33161 IRF: COVERAGES CERTIFICATE NUMBER:CL15123003431 REVISION NUMBER: (HIS 15 10 CtR11FY THAI IHE K)LK;IES Of INSURANCE LISItU BtLOW HAVt BttIY WSUEU IU (Ht INSURED IYAMW A80Yt KW IHVle(JLK:T PERM INDICATED. NOIVWHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WH1CH THIS CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS ABJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF DANCE POLICY NUMBER POUCY EFF UMRS X I COMME11tCIAL GENAL UAB1rrY EACH OCCURRENCE $ 1,000,000 A CLAIMS hflADE OCCUR PREMISES ffy aocw $ 100,OOO CBC20000460901 5/8/2016 $/8/2017 ME[)EXP{AW ompwwn) $ 5,000 :j PERSONAL&ADV(JURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY Q JELOG PRODUCTS-COMPfOP AGG $ --i-10041000 OTHER: EnVoyse Beness AiJTOMOSILE UABILfrY Ea $ B ANY AUTO BODILY INJURY(Per person) $ 10,000 � O$ AU OS OIIOFW0024918 5/7/2016 5/7/2017 BODILY INJURY(Per socidert) $ 50,000 HIRED AUTOS NON-OVVNEDAMAGE AUTOS p�acade� $ 50,000 5 t!l LA UASOCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MAS AGGREGATE $ DED RETENTION $ WORmtERS COMPENSATION AND EMPLOYERS'LIAB9 ftY STATUTE PROPRIErORIPARTNEIWEXECUT IVE y{N E.L.EACHUTE I E DTH- ANY PET OFRCER1MEME3ER EXCLUDED? F]NIA $ 500,000 C (Maft tory In I" THCSS16973 12/112015 1211/2016 E.L.DISEASE-EAEb9PLOY $ 500 tr00 If s describe mer iJESL�REPT�N OF OPERATIONS below E.L.DISEASE-POLICY LIMFr $ 500 000 DESCRIPTION OF OPERAMONSI LOCATIONS I VE NCLES(ACORD 101,Addidwrel Remeks Sdodule,maybe athwhad H more space is required) Plumbing Contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE iais�.ni C�IIOL'6S V11lr3gC Building rmpi; THE WA—MON MA7'M 7HSRE mOTM WL, Soa tAyEpMs arum 10050 HE 2nd Ave ACCORDANCE WETH THE PAY PROVI>NOHB Hdami Shores, 1% 33138 AUTHOR REPTATIVE D Boatwright/DA`dIDB ' ^ 0 9888-2014 ACORD CORPORATION, All rights reserved. ACORD 25(201 The ACORD name and logo are registered marks of ACORD INS025 poi,4o1)